Intracranial bleeding following head trauma is a major medical concern for the modern U.S. warfighter and civilian population. Since there is no practical point of injury treatment for intracranial bleeding, death or permanent neurological injury becomes increasingly likely as treatment is delayed during transportation to a medical treatment facility.
Battlefield and point of injury treatment of intracranial hemorrhage is nearly nonexistent. There is very little a field medic or first responder can do to mitigate the consequences of intracranial bleeding in the first moments after injury. The best option available to the medical personnel is to prepare the patient for rapid evacuation to a surgically capable medical treatment facility. The unfortunate consequence is that neurological damage or death becomes increasingly likely as time passes. This applies to civilian situations as well. Closed head injuries are very common injuries resulting from automobile accidents, blunt trauma, and sports injuries. Cranial hypothermia has been used for many years in an attempt to slow the progression of central damage. Hypothermia is intended to reduce inflammation, limit bleeding, and retard metabolism. This technique has been demonstrated to reduce the long-term neurological injury resulting from aneurysm; however, this technique is logistically impractical on the battlefield or accident site and does little to address the underlying cause.
Closed head injuries with edema greater than 1 cm2 have a mortality rate of 89%. The time from injury to treatment is of critical importance in the treatment of intracranial hemorrhage. Classically, superficial intracranial hemorrhage is treated by drilling a burr hole through the skull to relieve intracranial pressure. If the patient survives, a neurovascular surgeon would then intervene to stop the bleeding. Unfortunately, the classical medical and surgical intervention is limited to the medical treatment facility, long after the progression of the injury may have become fatal.
Traumatic brain injury (TBI) resulting from intracranial hemorrhage is a major cause of death and permanent disability for modem warfighters and in the civilian sector. Advances in protective body armor have contributed to the reduction in U.S. warfighter mortality. Injured warfighters that would have previously suffered fatal bodily wounds are presenting with injuries such as TBI. The TBI damage resulting from the initial blast or concussion is commonly exacerbated by subsequent intracranial bleeding. Intracranial hemorrhage commonly occurs when the soft tissues are displaced relative to the skull and meninges, creating damaging shearing and crushing forces. As the hemorrhage progresses, the blood confined in the volume of the skull displaces the brain, further damaging the tissues. Additionally, the intracranial pressure increases with the blood pressure from an arterial rupture. This increased pressure resists adequate blood flow to all the tissues within the closed volume resulting in widespread neurological damage. The options for point-of-injury treatment are severely limited. If the injured patient survives the transport to a treatment facility, a burr hole and craniotomy are the first line of treatment. Significant time may pass between injury and treatment, usually resulting in additional disability or death. Field medics and medical-evacuation personnel are substantially unequipped to treat intracranial bleeding in the first critical moments following injury. Point-of-injury treatment of intracranial bleeding would decrease the extent of secondary insults and decrease mortality.